Ridgewood Historical Society

Reimbursement / Check Request Form

 

Fill out this form, print and sign.  Return it to the Schoolhouse Museum marked "Attn: Kim Reis".

If you prefer, you can print this form and fill it out by hand.

 

Name:

Date:

Phone:

 

 

Vendor/Store

Expense Description

Amount

1)

2)

3)

4)

5)

6)

7)

8)

Total:  

 

Check Distribution:

Make Check Payable To:

Mail Check to the Following Address:

 

Other:

 

For Treasurer Use Only

Check #:_________

Check Date:____________

Prepared By:_____________________

 

Signed By:_______________________

Computer Entered

Signed By:_______________________